Alan Morrison on

Bedlam – London and Its Mad
by Catharine Arnold
Simon & Schuster UK Ltd., 2008
277pp, ISBN 978-1-84737-000-6

Lancing the Boil of Madness

'...the onomatopoeic clangour of the word 'Bedlam' itself,
suggesting an infernal din, like a bedstead falling downstairs...'
from Catharine Arnold's Introduction

Don't be put off by the rather ham-fisted Hell-red, Hammer Horror-style lettering on this book's cover - nor by the author's at-one-remove, wholly empathic experiences of mental illness: Catharine Arnold’s Bedlam – London and Its Mad is modestly titled – not to mention, arguably, tautologically for Londonphobes such as myself – since this is a book which more ambitiously attempts to chart the history of mental health diagnosis and treatment in England from, the founding of Bethlehem (to evolve through consonantal shift through 'Bethlem' to its eventual 'Bedlam') Hospital in the reign of Henry III by one Simon FitzMary, then Sheriff of London. Using Bedlam both as a focal point of research and record and as a motif for mental health establishments down the ages in general, Arnold actually undertakes a macro-survey of the history of treatments, diagnoses and theories on the nature of mental illness from the 13th century right up to the modern day and our post-apocalypse of that Thatcherite abomination ‘Care in the Community’ – taking in the seminal contributions of the likes of Sartre, Freud and RD Laing along the way. The result is about as detailed and colourful an overview of such eclectic a subject as one might reasonably expect in only 277 pages.

Arnold’s prose style is a very readable medley of journalistic salience, academic precision and poetic colour. It is, indeed, surprisingly for an essentially academic tome, markedly poetic both in aspects of its style and focus, as well as in its many germane and well-chosen extracts from various historically situated Bedlam commentators, including observations by the lugubrious Samuel Johnson – an expert on ‘literary madness’, a ‘borderline’ observer of Bedlam - as were many empathically driven literary tourists - due to his own often overwhelming obsessive preoccupations; commentaries by the similarly obsession-afflicted Jonathan Swift; and vivid descriptions by Charles Dickens on his various morbidly investigative visits, which include such insights as his noticing ‘the taciturnity of mental patients: ‘there is no solitude more complete’’; not to mention extracts from germane poems by the likes of Nicholas Breton (c. 1545-1626), William Blake (‘London’) and John Keats’ masterly apt ‘Ode to Melancholy’, one of the most consummate poems on depression in the English language, which poignantly closes this book.

Keats himself, somewhat unusually for such a sensitive, poetry-nurtured mind of his time, wasn't among the legion similar men of letters to have found themselves at a point in their psychically turbulent lives within the grim walls of the Bethlehem Hospital, or some other similarly harrowing asylum (though he did ultimately succumb to the consumption which seemed the natural nemesis of poets of the period). His poet predecessors John Bunyan (self-tormenting author of Pilgrim’s Progress who it’s argued today suffered from a blasphemy-centred form of obsessive-compulsive disorder), William Cowper, Christopher ‘Kit’ Smart (hartshorn-induced religious mania), William Collins, Thomas Fitzgerald had been at one point inmates of Bedlam (and - arguably Keats’s natural poetic harbinger - John Clare ended his days in Northampton General Lunatic Asylum for worsening mania). There’s also much exposition given to the harrowing case of Mary Lamb (1764-1847), known ever since as ‘the sister of Charles Lamb’, he being the famous poet, who dedicated the rest of his life to looking after his ex-Bedlamite sibling, who years earlier, through a deadly combination of disappointed literary aspirations, poverty and an over-demanding invalid mother, committed matricide. There is also some particular attention given to possibly Bedlam’s most famous artist lunatic, Richard Dadd, as famous for his genius grotesque painting style as for the fact that he murdered his father believing him to the be the Devil incarnate.

But Arnold really brings the urgency of such an in-depth study of Bedlam to the fore in her fascinating picaresque accounts of the madness-induced infamies of numerous lesser known historical 'lunaticks', such as would-be regicides James Hadfield (c. 1771–1841) – who had been convinced by a religious fanatic, Bannister Truelock, that the Messiah himself would come forth from the minister’s mouth but for the obstacle of the reigning King, George III, whom Hadfield then attempted to assassinate – and Margaret Nicholson (1745-1828), who tried to kill the same benighted regent with a cake knife. There’s also the sad and macabre tales of patients such as Alexander Cruden (1701-70), a diminutive Scottish eccentric who wrote a reference book for the Bible called Concordance; Richard Farnham, who, unable to distinguish between the actual and the figurative was driven to religious delusions in his literal reading of the Bible (a condition termed 'entusiasme' by one Meric Casaubon (1655)); James Tilley Matthews, self-confessed but innocent spy, who believed that a ‘criminal gang, profoundly skilled in pneumatic chemistry’ imposed thoughts in his head against his will via a bizarre mechanism he called ‘The Air Loom’ (which he painstakingly detailed in a series of drawings), operated by an insidious ‘Glove Lady’; Urbane Metcalf, a hawker and door-to-door ribbon-seller who laid a claim to the throne of Denmark; And from Bedlam’s Colney Hatch site: Dorothy Lawrence (1896-1964) who was incarcerated for her last forty years following her attempt to disguise as a male soldier, Dennis Smith, in order to fight in the First World War; Aaron Kosminski (1865-1919), a Polish Jew whom some believed was ‘Jack the Ripper’; Robins the Ranter, and so on. Apart from some of the bizarre and grotesque details of these various inmates’ former lives, the names of said characters and those – patients and custodians alike – incidental to their misery stories are like something out of the titular caricature of Dickens himself: Dr Helkiah Crooke, Alderman Fowke, Dr Edward Mapother, Ludovic Muggleton (founder of the Muggletonians who, along with the brilliant John Lilburne, was among many religious ‘eccentrics’, or dissenters, to be buried in Bedlam Yard), Sir George Onesiphorous Paul, Bannister Truelock, Dr Yellowlees, Mr Baccus and Mr Popplestone – the list of appropriately Dickensian names goes on.

Regarding the monarchy and its relationship with madness through its various reigns, one can clearly see that the broader public attitude and perception of ‘madness’ was reflected against the occasionally bizarre and invisible infirmities of its Kings: Richard II’s post-ousting madness aside, the populace had to contend with the fragrant insanity of neurasthenic Henry VI, almost by way of a dynastic motif for the madness of national internecine feud in the wake of the Wars of the Roses, and later on, of course, the legendary ‘madness’ of George III, which was fairly epic in its sweep and a cause for continual embarrassment for the British establishment of the time (along with the Prince Regent’s less excusable profligacy, in his father’s strait-jacketed absence). In terms of monarchic patronage of the charitable institution of early Bedlam, various Kings can be seen to have been surprisingly compassionate and empathetic, a handful of Plantagenets among them, most notably Henry III, under whom the Hospital was originally designated, and later, that otherwise historically demonised figure, Richard III. Centuries on, Oliver Cromwell also showed a surprising benevolence towards the suffering of Bedlam’s inmates, even if, a little duplicitously – as was common of course for Cromwell – the very Puritanism he championed often enforced the belief that insanity was a form of demonic possession owing to intrinsic sinfulness in its victims; a perverse aetiological view which sanctioned such absurd and brutal practices as trepanning (see later). It was famously espoused under the euphemism ‘enthusiasme’ by one Meric Casaubon in 1655 (more than whose mere name possibly inspired the austere clergyman Edward Casaubon in George Eliot’s masterpiece Middlemarch?).

A common-held psychiatric view, that those in any form of public office were especially susceptible to madness, later developed in view of the fact that not only selectively bred monarchs, but also the less special pedigree of political figureheads were also not immune to breakdown and insanity: the electorally defeated and thence ‘raving mad’ Opposition Leader Charles Fox, and the acutely sound-sensitive William Pitt The Elder, for two.

But the book itself justifiably obsesses on the theme of ‘literary madness’ and indeed the numerous literary leitmotifs of madness throughout English literature, prime examples being Shakespeare’s ‘Poor Tom’ from King Lear (which became the definitive symbol of the insane stereotype since) and his Ophelia from Hamlet; later, Dickens’ cobwebbed recluse Miss. Havisham from Great Expectations, and Charlotte Bronte’s Bertha Mason from Jayne Eyre (superbly expanded on by Jean Rhys’s acutely empathetic prequel Wide Sargasso Sea), cruelly afflicted by a progressive inherited insanity which manifests in pyromania (as it does too, ironically, with Dickens’ Miss Havisham, which Freud might have suggested were behavioural expressions of suppressed Elektra Complexes). My only quibble here is the absence of mention of that other lingering motif of feminine insanity in our literature, Charlotte Perkins Gilman’s creatively starved Doctor’s wife who through prolonged isolation in a country retreat by way of a feeble ‘rest cure’ for her ‘nerves’, comes to believe herself to be incarcerated in The Yellow Wallpaper (1891).

Arnold’s Bedlam is as much a meditation on the evolution in perception on mental illness (or ‘madness’) in medical, social and human terms, as it is on the role that language has had to play in articulating it and, through moulding and shaping its representation on the page, so too symbiotically transforming (more than in the metaphorical sense) its very fabric (progressive and flexible as it often is), and thus in turn exposing more about its aetiology. Language, especially in terms of labelling certain conditions for the first time (as phrenologists had literally done on their brain-mapped porcelain heads), and in describing each disorder’s often numberlessly varying symptoms, can be clearly seen to have played an enormous part in the definition, identification and dissection of psychiatric malaise (not to mention being one of many prime symptomatic markers of certain psychotic states, as in the phenomenon of ‘word salads’, the jumbling together of various - and often un-obviously associated - units of vocabulary into single units, as in ‘realdreamlike’, etc. which smacks of an infantile linguistic regression; a spontaneous quirk which was used as a literary ‘stream-of-consciousness’ dream-device by James Joyce in parts of Ulysses and the entirety of Finnegan’s Wake, as if by some strange homage to the author’s daughter, Lucia’s, decent into chronic schizophrenia; the ingenius gobbledigook of Lewis Carroll's 'Jabberwocky'; and, on an even lighter note, as a verbal comedic device by Professor Stanley Unwin). Certainly there’s a strong case for the subverting and re-entangling of dissociative word units and syntax as being symptomatic of the disentangling of ‘rational thinking’ which often spells a lapse into extreme psychosis.

Social history comes into play frequently in Arnold’s wide-sweeping research, which might be called tentatively a 'sociology of madness'. Particularly fascinating is the assertion, fashionable at the turn of the 20th century, that out of the three main classes in society, insanity and other mental illnesses afflicted the middle-class most of all, due to – as the theory went – the excessive transitive stresses of this class’s sense of the need for social self-betterment and ‘keeping up appearances’ so to speak, and its intrinsic positioning in the no-man’s-land between class tensions and lifestyles, a sort of ‘midstairs’ (as opposed to the more cleanly defined Upstairs, Downstairs paradigms made famous in said Seventies’ costume series) hinterland besieged by the two-way missiles of the classes either side (which arguably made the middle-class uniquely placed to produce some of the most progressive social and political ideas of their times, most significantly, Fabianism at the turn of the 20th century). This sociological proposition indeed makes much sense and brings a fascinating class-dimension to madness and its perception – and indeed, many of the literary rankers among the human traffic of Bedlam’s cells would have been placed broadly as middle-class.

In tandem with such theories comes a brief digression on the perceived hysterics of the Suffragette movement and the subsequent forced-feeding methods of their jailers. But a more detailed and comprehensive section is given over to the First World War phenomenon of ‘shell shock’ or, as it was equally evocatively referred to by practitioners at the time, ‘Disordered Action of the Heart’; and it is noted at this juncture in the book that from this point on in psychiatric theory, a new emphasis was put on the partial physiological aetiology of some forms of ‘insanity’ via the greater neurological debate necessitated by the wide-varying symptoms of ‘shell shock’. The gist here is that the medical establishment was somewhat shocked itself at the fact that, contrary to contemporaneously recent, draconian Social-Darwinian theories such as eugenics – that some humans simply had defective genes and should thus be sterilised so they could no more procreate – the larger number of ‘shell shock’ cases were among the well-heeled, well-educated middle and upper classes of the officers, and far less so among the perceived inferiorly bred working and lower classes who formed the army’s lower ranks. In a sense, at this moment in history, theoreticians were forced to consider the possibility that much of this was obviously down to the fact that many young officers, fresh out of Eton or Oxbridge, had scarcely tasted life in Civvy Street before being expected to blindly lead their troops into the oblivion of German bullets:

...they were out of their depth, facing a war for which no amount of drill or immersion in the military tactics of the classics could have prepared them. Lacking essential leadership skills, they succumbed at twice the rate of the ranks. [pp254]

But such enlightened insights into the clear emergence of a neurological disorder were still at war with less compassionate assertions by military apparachiks that ‘shell shock’ was more a ‘disciplinary’ condition ‘suffered by shamming malingerers’, and by 1918 had become ‘a ‘parrot-cry’ at courts martial’. Nothing like good old-fashioned military cynicism, is there? Inevitably there is, further on in this chapter, detailed mention of the famous work of the Craiglockhart Hospital, and its two shell-shocked poet sojourners, Siegfried ('Mad Jack') Sassoon and Wilfred Owen.

Numerous and various landmarks in mental health evaluation and analysis throughout the centuries are mentioned at length in Bedlam, ranging from the physiological fluid-based theories of Robert Burton’s seminal The Anatomy of Melancholy (What it is: With all the Kinds, Causes, Symptomes, Prognostickes, and Several Cures of it; (1621)), which re-asserted the Gaelic Regimen Sanitatis tradition of the four ‘humours’, blood, bile, phlegm and choler (‘the sanguine, the phlegmatic, the bilious and the melancholy’; nowadays superseeded by the chemical theory of brain serotonin), the levels in our bodies of which were thought to determine our temperaments (a compassionate leap of scholasticism by a man who was, however, otherwise prone to condemning religious dissenters such as recusants, closet Catholics, as suffering from religious manias); through the various oddities in phrenological ideas of brain-mapping (nowadays adapted into less nuanced and specific lobal cartography) and the shape of the head as an anthropomorphic aid to mental pathology; Freud’s psychosexual treatises; to RD Laing’s now controversial anti-psychiatric ideas of ‘madness’ as a natural human process which requires not restraint, but free reign for eventual catharsis (that a breakdown is more a 'breakthrough' in the 'transcending of the ego' into the 'authentic self'; see The Politics of Experience and The Bird of Paradise, 1967). The book includes a priceless exposition on the phraseology first employed in the original diagnoses of certain psychiatric conditions. There’s ‘Emil Kraepelin’s model of ‘dementia praecox’, first used by Morel in 1860 and described as ‘irrevocable cortical brain disease and enfeeblement in the young’, which later an assistant of Kraepelin’s, one Alzheimer, in failing to pinpoint a physical aetiology, accidentally discovered ‘neuropathological changes characteristic of a form of presenile dementia’, that led to the first diagnosis of the eponymously named illness. As well as this, there is mention of Eugen Bleuler’s diagnostic coining of ‘schizophrenia’ in 1908: ‘I call it “schizophrenia” ... because the “splitting” of the different psychic functions is one of its important characteristics’. A definition which later sages such as RD Laing (The Divided Self et al) re-emphasised vehemently against the growing popular misconception of schizophrenia meaning ‘split personality’, when what it actually meant was a split in psychic functioning in relation to reality and a mental blur between it and fantasy/delusion. (There are also some incidental etymological insights thanks to Arnold’s extensive scholarship, including the name of one of Bedlam’s more progressive governors, William Battie (sometimes spelt ‘Batty’), who took over the asylum in 1754, and from whom, presumably, the derogatory term ‘batty’, a slang for ‘mad’, derives).

Equally fascinating – though grisly – are the many accounts of the frequently barbaric fashions in mental health treatment, including excessive strait-jacket and leather-strap restraints, the hot-and-cold bath procedure, trepanning (not a Cornish village, but one of the oldest ‘madness cures’ which entailed boring a small hole in an un-anaesthetised patients’ skull in order to let out the evil spirits from the mind), and particularly disturbing accounts of a device known as 'the Chair', in which some patients were strapped, its legs being welded to an immovable slab of concrete; and the now comparatively ‘softly softly’ approach of pharmaceutics (anti-depressant and anti-psychotic medications). Details throughout the book of the extreme privations inherent in accommodating London’s ‘Lunatick’ population, such as freezing damp cells in which patients had to sleep naked on straw, are particularly eye-opening. Naturally, of course, the perennially controversial treatment method of electro-convulsive therapy (ECT) or electric shock treatment (EST) is mentioned in numerous incarnations in its development and application throughout the book; most interestingly of all, in relation to its employment in attempting to cure sufferers of ‘shell shock’, under its lesser known name of ‘faradisation’, or faradism. More constructively, and harking forward to later developments such as what is now known as Occupational Therapy*, Arnold relates of seminal occupational methods originally employed by way of providing a much-needed ‘fillip’, or stimulation, for patients (modern stereotypes of basket-weaving classes have, naturally, abounded ever since). [Note: *OT is psychiatric rehabilitation through meaningful activity, often of a creative nature, which nowadays, having cast off its flirtation with atomist Rationalism - sparked by the industrial revolution - and through theories of Sixties' Holism, returned in part to its roots in the Arts and Craft Movement of the late 19th/early 20th century - which was in turn inspired historically by the rhyming Gaelic recipe for wellbeing, the Regimen Sanitatis].

Rather like a symbiotic House of Usher, even the very distinct and pseudo-Gothic architecture of the later Moorfield’s incarnation of Bedlam Hospital is put under the magnifying glass by Arnold through various colourful descriptions of the buildings’ imposing aesthetics, perhaps most notably from poet Alexander Pope’s The Dunciad: ‘o’er the gates, by his famed father’s hand, Great Cibber’s brazen, brainless brothers stand’. Here Pope refers to the macabre ‘Brainless Brothers’ sculptures 'raving over the gateway of ‘New Bedlam’' (although the gargoyle-like sculptures were not standing, but actually reclining, albeit restlessly, over a porch on the gateway). These ‘massive statues, carved in Portland stone’, which ‘represented the two forms of madness: dementia and acute mania’, were designed by one Caius Gabriel Cibber, father of the famous dramatist Colley Cibber, and are further described as ‘Oppressive and pitiful in their depiction of madness and despair’, and they certainly resemble this description if one is to go by the disturbing engraving provided in the book. Even more disturbingly, they came to form something of a lugubrious 'corporate motif' for the Hospital.

In a similar vein, visual representations of Bedlam are painstakingly described by Arnold through examples of contemporary satirical cartoons by the likes of William Gillray and Thomas Rowlandson, blatantly exploitative even in the Age of Reason and Enlightenment – still centuries short of our own age of Political Correctness – as in the exposition below:

In A Peep Into Bedlam, Rowlandson shows ‘Peter Pindar’ (John Wolcot), the Grub Street hack who ridiculed the private life of George III in The Lousiad and Ode upon Ode which are lying on the floor. Pindar is shown in the pose of the mad scribbler, a common Bedlam stereotype. Opposite sits Edmund Burke .... Shaved and naked to the waist, he tramples copies of Tom Paine’s Rights of Man and clutches a rosary, implying that he was a Roman Catholic like his mother, and aligning him in the popular consciousness with the religious maniac....

Clearly political lampooning through satirical cartooning was a particularly tawdry affair in this period, and oddly in spite of the King’s own well-known insanity at the time, which one might have thought would have given the subject of madness more the status of a taboo than a public laughing-stock. Having said this, Arnold relates the even more tawdry and sordid fact, throughout several decades, during which Bedlam was subsidised in part by being opened to the public as an immobile freak circus, people coming to openly gawp and mock at the pitiful ravings and physiognomic oddities of many of the inpatients, as if they were visiting a zoo.

All in all, Arnold has produced a breathtakingly wide-sweeping and eclectic look at very much more than simply a detailed and eye-opening history of the Bethlehem Hospital in London and of its variously famous and notorious inhabitants; she has also managed, brilliantly, to encompass a general overview of the history of mental health and psychiatry in England, the timeless link between creative genius and mental illness, the evolution in methods of treatment and diagnosis, and in international psychiatric theories, but most fascinatingly for me, a comprehensive illumination of ‘madness’ as an all-encompassing human phenomenon which historically both transcends and at the same time distinctly arbitrates across the vast map of artificial social constructs such as class, status, education, material circumstance, diet, heredity, experience and trauma. That in a sense, madness is a human phenomenon which, in both a positive and negative sense, reaffirms the commonality of our species. This book is essential reading for anyone interested in that irresistible medley of psychiatry and social history.

Alan Morrison © 2009